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Common Congenital Heart Lesions - page 67 / 126

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      Maybe ST segment elevation

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        These changes quickly normalize with resolution of symptoms

  • Exercise Stress Test ***Note: this is one of the objectives!***

We do this test when the ECG is normal. Because it is hard to catch someone at the time of an ischemic attack, their ECG will most likely be normal. Thus we cannot rule out ischemic heart disease based on ECG alone. The test is not useful for patients unable to exercise (severe arthritis).

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    Patient exercises until angina develops, until there are signs of ischemia on the ECG (see above), target heart rate is achieved, patient gets too tired.

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      POSTIVE TEST:

      • Patient’s typical angina is recreated

      • ECG shows signs of ischemia Æ ST segment depressions, 1 mm

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      MARKEDLY POSITIVE:--indication of severe multivessel disease

      • ECG changes seen within 3 minutes

      • Persist for more than 5 minutes after test is stopped

      • ST segment depressions > 2 mm

      • Systolic BP DECREASES during exercise

      • Ventricular arrythmias develop

      • Patient cannot exercise for at least 2 minutes

When considering doing an exercise stress test, remember that several things can affect the results. If the patient is taking a beta-blocker, then optimal heart rate may never be reached. If you are doing the test to see if ischemic heart disease is present, ask the patient to stop taking the beta-blocker for 24-48 hours before the test. If you already know the patient has ischemic heart disease, you can use the test as a means of assessing current medical regimen.

Other diagnostic studies—briefly

  • Nuclear Exercise Study:

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      look at areas of poor perfusion during exercise

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        allows determination between ischemic areas and necrotic/infarcted areas.

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        Expensive

  • Exercise Echocardiography:

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        LV contractile function is assess, at baseline and after exercise

  • Pharmacologic Stress Tests

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        Used for folks who can’t exercise

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        DOBUTAMINE – increases force of contraction

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        DIPYRIDMOLE or ADENOSINE—vasodilators

        • Dipyrimidole blocks uptake of adenosine so there is more circulatingÆvasodilation.

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